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This is VAERS ID 966359

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 966359
VAERS Form:2
Age:77.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Headache, Injection site pain, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Gabapentina, furosemide, Losartan, pravastatin
Current Illness: Diabetes, hyper tension
Preexisting Conditions: Diabetes
Allergies: Aleve
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache, pain in the injection site, threw up. A few hours later she died.


Changed on 5/7/2021

VAERS ID: 966359 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Headache, Injection site pain, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Gabapentina, furosemide, Losartan, pravastatin
Current Illness: Diabetes, hyper tension
Preexisting Conditions: Diabetes
Allergies: Aleve Aleve
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache, pain in the injection site, threw up. A few hours later she died.


Changed on 5/14/2021

VAERS ID: 966359 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Headache, Injection site pain, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Gabapentina, furosemide, Losartan, pravastatin
Current Illness: Diabetes, hyper tension
Preexisting Conditions: Diabetes
Allergies: Aleve Aleve
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache, pain in the injection site, threw up. A few hours later she died.

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